Introduction Neonatal jaundice (NNJ) affects up to 60% of term and 80% of preterm infants and is usually a benign phenomenon. Profound early NNJ is a cause of kernicterus and prolonged NNJ can be a sign of life-threatening conditions, the most common of which is extrahepatic biliary atresia (EBA). Our aims were to describe the change in prevalence of hospital admission for NNJ, kernicterus and EBA and to establish how many cases of EBA were diagnosed after an admission with NNJ.

Methods All admissions to hospitals in Scotland between 2000 and 2013 for individual aged <16 years were analysed. The first admission with NNJ, kernicterus and EBA were identified from coding, repeated admissions were not considered. Individuals born before 2000 were not included in the analysis. The incidence of NNJ admissions and incident cases of EBA were standardised to number of deliveries per annum.

Results There were 8 30 401 paediatric admissions of which 2464 were for NNJ and 33 for EBA. There was one case of kernicterus. The incidence of NNJ admissions was 2.2/1000 live births in 2000 and this rose to 7.0/1000 in 2013. Very few NNJ admissions occurred in the West of Scotland. The incidence of EBA was 0.42/10000 live births (or 1 case for each 23 687 live births) between 2000 and 2013, and did not increase during this period. The ratio of NNJ admissions: incident EBA cases rose from 25:1 to 164:1 between 2000 and 2012. 17 (52%) cases of EBA had a prior admission with NNJ.

Conclusion This whole-population study demonstrates different pathways for assessment of NNJ in Scotland. In regions where NNJ is assessed as an acute inpatient admission, there has been a threefold rise in admissions but no rise in the prevalence of EBA. Given the continuing rise in NNJ referrals, guidelines for referral may require amendment.